Provider Demographics
NPI:1669195038
Name:SHORTEN, SARAH KIMMEL (PHARMD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:KIMMEL
Last Name:SHORTEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6745 JOSEPH NELSON CT
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-9506
Mailing Address - Country:US
Mailing Address - Phone:765-426-2050
Mailing Address - Fax:
Practice Address - Street 1:6745 JOSEPH NELSON CT
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-9506
Practice Address - Country:US
Practice Address - Phone:765-426-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20621135A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist